Anthrax scares are spreading across the country like an
infectious disease, raising questions and fears in equal measure. Here's what
the experts in federal health agencies and the U.S. Postal Service say about
anthrax and what to do if you come in contact with it.

Q: How can people be infected with anthrax?

A: There are three ways the bacterium Bacillus anthracis,
which causes anthrax, can get into the body, and all can be deadly if not treated.

Cutaneous or skin anthrax occurs when the bacterium enters
through a cut or scrape. It causes a lesion that turns black in the center.
There can be swelling in the area, along with fever or achiness. When treated
with antibiotics, most people recover. Left untreated, cutaneous anthrax can
cause death in about 20% of cases.

Inhalation anthrax is the most dangerous form of the disease
and is nearly 100% fatal unless antibiotic treatment begins soon after exposure.
To be infected, people have to breathe in the spores, which must be sprayed
in a very fine mist. If particles are too large, they will fall to the ground
and bind to particles in the dirt. However, if they're the right size to be
inhaled deeply into the lungs, they can grow and infect the blood and lymph
system. Illness begins with flulike symptoms that progress in a matter of days
to severe breathing problems and shock.

The third route of infection is through eating contaminated
food, causing gastrointestinal anthrax. Symptoms include nausea, loss of appetite,
vomiting and fever, followed by abdominal pain, vomiting of blood and severe
diarrhea. It causes death in 25% to 60% of cases.

Q: Is it contagious?

A: No, anthrax cannot be passed through the air from person
to person, even after a victim has developed symptoms. Relatives and contacts
of people who may be infected do not need to take antibiotics.

The exception is that with cutaneous (skin) anthrax, direct
contact with the drainage from an open sore can spread the bacteria.

Q: What kind of mail should be considered suspicious?

A: The U.S. Postal Service, which has information posted
at www.usps.gov, says to be wary of mail that has any powdery substance on the
outside, strange odors or stains. If it's from someone unfamiliar, has excess
postage, is addressed to someone no longer with your company, has no return
address or one that doesn't appear legitimate, that, too, should trigger suspicion.
Mail that is of unusual weight, lopsided or oddly shaped, has an unusual amount
of tape on it, is marked with restrictive endorsements, such as "Personal" or
"Confidential," or shows a city or state in the postmark that doesn't match
the return address, be on the alert.

Q: If a suspect piece of mail is found, what should
be done?

A: Put it down and leave it alone. Call a supervisor and
the police. The postal service says you should not handle, smell or taste the
contents of the suspicious envelope or package. Cordon off the area and make
sure that anyone who touched the piece of mail washes his or her hands with
soap and water. List the names of anyone who touched the mail, along with contact
information, and give it to police. Take a shower and put all items worn when
in contact with the mail into a plastic bag available for police investigators.

Q: Can I sterilize my mail by ironing it or putting
it in the microwave?

A: Centers for Disease Control and Prevention spokesman
Tom Skinner says the agency cannot comment on "unproven methods of decontamination."

Q: Why do medical personnel do nasal swabs?

A: The CDC says nasal swabs, which are taken using a long-handled
cotton-tipped swab, are used during investigations of known or suspected anthrax
exposures to help assess how wide the circle of possible exposures might be.
The tests are not 100% accurate: A negative swab test doesn't rule out possible
exposure. There is no lab test to determine exposure, says David Fleming, deputy
director of the CDC. He says antibiotics are given to people who, based on their
history, may have been exposed. People who have not been in an area where anthrax
has been detected, but who are still worried, should contact their local health
department for guidance, he says.

Q: What's the difference between exposure and full-blown
anthrax disease?

A: An exposure means you have been in contact with anthrax,
but it does not mean you got enough of it to make you sick. The greater the
exposure, the more likely that you will develop the disease, unless antibiotic
treatment begins right away. People who have been exposed to a piece of mail
or other item suspected to be contaminated with anthrax are given antibiotics
right away to prevent illness.

Q: What antibiotics?

A: Cipro is approved for use against inhalation anthrax,
mainly because there has been concern about the potential use of strains of
anthrax that have been genetically modified to resist other antibiotics. Non-genetically
engineered, naturally occurring anthrax can be treated with several different
antibiotics, including penicillin and doxycycline.

Q: What other tests are done?

A: Blood tests may be done to detect antibodies, the body's
infection fighters. Two antibody tests are needed, to compare the change in
antibody response over time. To confirm anthrax disease, doctors may take samples
of blood or spinal fluid and try to grow the bacteria on a plate. They also
may examine tissue under a microscope or use a technology called PCR, polymerase
chain reaction, to amplify tiny amounts of DNA, proving the presence of anthrax
bacteria.

Q: How do you clean a building or office following an
incident?

A: CDC's Fleming says the Department of Health and Human
Services is working with the Environmental Protection Agency to "develop appropriate
decontamination procedures." Spores released into the air eventually will fall
to the ground and no longer pose a serious risk of inhalation anthrax, though
they could still cause cutaneous anthrax.

"Decontamination will focus on cleaning the surfaces and
testing to be sure the area is clear," he says. Bleach is effective to sterilize
surfaces.